Provider Demographics
NPI:1053120097
Name:BELOUSOVA, OLGA (LMT)
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:BELOUSOVA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:OLGA
Other - Middle Name:
Other - Last Name:LYONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1201 MAYPORT LANDING CIR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32233-6508
Mailing Address - Country:US
Mailing Address - Phone:904-451-6138
Mailing Address - Fax:
Practice Address - Street 1:1201 MAYPORT LANDING CIR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32233-6508
Practice Address - Country:US
Practice Address - Phone:904-451-6138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-03
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL55644225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist